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General NPI Number Information
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NPI Number | 1114082773
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Entity Type | Organization
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Legal Business Name | X-RAY NORTH GROUP PSC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | CARR 490 KM 2 BO HATO ARRIBA
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City | ARECIBO
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State | PR
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Zip | 00612
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Country | US
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Telephone | 787-879-0750
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Fax | 787-879-0772
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Provider Business Mailing Address
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Address Line | PO BOX 142292
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City | ARECIBO
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State | PR
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Zip | 00614-2292
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Country | US
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Telephone | 787-879-0750
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Fax | 787-879-0772
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS A RODRIGUEZ
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Credential | M.D.
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Telephone | 787-879-0750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 229776
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License Number State | PR
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